Posters for 2023 Autumn Meeting

Introduction: In 2021 the NHS Business Services Authority Data Science team openly published the first comprehensive nationwide analysis of over 65 care home versus non-care home prescribing. The analysis has been expanded to include three years of prescribing data and key falls risk prescribing metrics, offering new insight into falls risk prescribing for the over 65s in England. Method: Patient address information from 1.8bn prescription forms was matched against 35m Ordnance Survey Address Base addresses. Patient addresses from prescription forms were classified as belonging to a care home

Background: North Middlesex University Hospital runs an outpatient frailty service offering Comprehensive Geriatric Assessment. There is a daily ‘hot slot’ for patients who may otherwise require unplanned admission if not seen within seven days. Aim was to improve slot utilisation from 50 to 100%, with appropriate admission avoidance referrals by June 2023. Empty slots result in an inefficient use of resources, increased workload in other departments and reduced opportunity for patients to benefit from the service. Methods: We audited hot slots in November and December 2022, marking slots as

Introduction Dehydration is associated with prolonged hospital admissions and complications. Elderly patients are more susceptible due to physiology, dexterity and cognition. The British Dietetic Association recommends minimum 7 beverages per day whilst The British Nutrition Foundation advises proactive dehydration risk management in hospital. This project aimed to reduce the proportion of elderly patients at risk of dehydration in hospital. Methods Staff documented oral hydration over 24 hours for patients on the Care of the Elderly ward. Additional factors obtained retrospectively included

Older people with severe frailty are 5 times more likely to die in the next 12 months than older non-frail people however prognosis and disease trajectory in frailty remains difficult to predict. Advance care planning (ACP) is often not fully discussed or documented due to these prognostic uncertainties, plus time/workload constraints. This can result in multiple admissions for people with frailty in the last 12 months of life and can lead to care and death in a non-preferred place. Electronic Advance Care Plans (eACP) can be useful in reducing unwanted admissions and promoting care and death

Introduction: In 2019, the Royal College of Physicians (RCP) advised that all patients should have their vision screened if identified as a falls risk. Our aim was to implement a bedside visual screening test and establish an onward inpatient referral to Hospital Eye Services (HES). Method: This is a collaborative Quality Improvement project involving Geriatric Medicine, HES and the Royal National Institute of Blind People (RNIB). A pilot study cross referenced falls admissions with previous known ophthalmic data to estimate the proportion of known vision loss in this group. In the second

Introduction There is a recognised association between white coat hypertension (WCH) and adverse cardiovascular outcomes in older adults. However, there is no consensus on the management of WCH in this group. The objective of the Hypertension in the Very Elderly Trial (HYVET-2) study was to assess the feasibility of randomising 100 patients >75years with WCH from General Practice in the UK to treatment or usual care. The study did not randomise any patients. In this follow up study, we sought to explore the reasons for not recruiting. Methods Using a mixed-methods study design, staff from 29

Introduction Upper limb recovery after stroke depends on participating in an individualised task-specific exercise programme. However, older adults with stroke find it challenging to maintain an optimal level of physical activity due to personal and environmental factors. The aim of this study was to explore the perceptions of patients and stroke therapists on home-based resistance exercises for upper limbs. Methods A qualitative study of semi-structured virtual and in-person interviews was conducted between January and March 2023 in England. Participants were 11 older adults (>65 years) with

Introduction In the UK, fifty-three percent of hospitalised older people with dementia have multimorbidity, and are at an increased risk of hospital readmission within 30 days from discharge. Between 20-40% of these readmissions are preventable [1]. Current research focused on the biological causes of readmissions. However, older people with dementia have additional psychosocial factors increasing their risk of readmission. The aim of this scoping review was to identify psychosocial determinants within the context of known biological factors. Methods Electronic databases MEDLINE, EMBASE

Introduction Commonly, discharge letters employ a chronological “narrative” style (NS). These unstructured letters often do not clearly communicate rationale for diagnoses and management – a problem exacerbated in letters compiled by multiple staff. This project trialled an alternative format. Methods An itemised letter (IL) was designed, each diagnosis a separate numbered point; guidance was provided for relevant investigations and management to include for core geriatric conditions. Four “Plan Do Study Act” (PDSA) cycles were completed. Mixed-methods feedback informed subsequent cycles. PDSA

Introduction: Meaningful involvement of experts by experience in the design of health and care research is now well-established as good practice (Staniszewska, 2018). For example, it is essential that the voices of residents and staff are properly heard in care homes research, since they provide important perspectives not necessarily shared by the wider multidisciplinary team (Shepherd et al. 2017). Nevertheless, there are concerns that involvement can be tokenistic, or vulnerable to power imbalances (Baines & de Bere, 2017; Jennings et al., 2018). Methods: A care home in north east England is

Introduction: Treatment Escalation Plans (TEPs) are helpful tools that reduce un-necessary treatment burden, improve patient experience and follow the principles of realistic medicine. This is relevant in orthopaedics where a high percentage of the patients are frail, co-morbid, and would benefit from clear and realistic care plans. We aim to improve TEP completion to >50% of orthopaedic patients, over the age of 65yrs old, in three trauma wards at the Royal Infirmary of Edinburgh by August 2023. Methods: We sampled three patient notes on each ward twice weekly from May – August 2023, noting

Background & Introduction In response to the recent publication of the new British Geriatrics Society undergraduate medical curriculum (1), the medical education department at Glasgow Royal Infirmary created a session focussing on frailty for undergraduate medical students. The aim of the session was to introduce the concept to students by exploring and expanding on their experiences of frailty on placement. Methods - The session We used a pedagogical approach in a short, 90 minute session for small groups of students. The session was split into three activities; the first activity was a case

Promoting Bone Health by ensuring in-patient Ortho-geriatrician Bone Health plan in patient notes following Neck of Femur Fracture (NOF). Introduction & Aims Osteoporosis affects 3 million people in the UK with more than 500,000 hospital presentations annually due to fragility fractures costing in excess of £4.4 billion to the NHS. Bone protective medications are a cost-effective way of reducing fracture and admission following a fall. The Royal College of Physicians National Hip Fracture Database targets that patients are: “given suitable bone strengthening treatment and followed up to ensure

Introduction Iron Deficiency Anaemia (IDA) is a highly prevalent co-morbidity in older patients with advanced frailty. It’s associated with adverse outcomes and heightened all-cause mortality. IDA is frequently multifactorial and can stem from various gastrointestinal causes. The British Society of Gastroenterology and National Institute for Health and Care Excellence advocate a combination of endoscopy and computerised tomography (CT) as the gold standard investigations for IDA. The aim of this review was to evaluate oesophagogastroduodenoscopy (OGD) findings and management outcomes of

Introduction: It is recognised that there are pressures on the NHS particularly the emergency services. Therefore, a focus of the 21/22 Priorities and Operational Guidance was to develop community services to prevent emergency department (ED) attendance and avoidable hospital admissions. This informed the funding of urgent community response services (UCR). An urgent response is defined as a presentation that would likely result in hospital admission if a response were not made within 2 hours. Quality Improvement methodology was applied to evaluate the potential impact an advance clinical

Older people with diabetes are often admitted with falls, dizziness or confusion that may stem from undiagnosed episodes of hypoglycaemia. We examined the use of a 10-day period of round the clock glucose monitoring (CGM), to detect hypoglycaemia in older people with diabetes with symptoms potentially related to hypoglycaemia. Methods Population: Age 75 years and older, on sulfonylureas and/or insulin, presenting to hospital with a fall and/or symptoms suggestive of unrecognised hypoglycaemia. Design: Single-centre, observational study (no change to standard diabetes care). Intervention: 10

Rationale Inpatient glycaemic management is a challenge in older people. Clinicians at the Norfolk and Norwich University Hospital noticed substantial numbers of finger-prick capillary blood glucose (CBG) tests being documented. This quality improvement project explored the frequency of CBG testing on older people’s medicine wards, to determine if improvements in service provision and patient safety could be made. Methods Setting: Electronic records of inpatients on geriatric medicine wards at NNUH (May-July 2023) Patient selection: Older people with recorded CBG testing Measures: 1. Type of

Introduction: Socio-economic costs of hip fractures are formidable. Despite osteoporosis and falls being major risk factors, preventative screening in Primary Care does not occur. Evidence shows screening older women for osteoporosis prevents hip fractures, but to make a greater clinical and economic impact simultaneous screening of falls and fracture risks is logical. This cross-sectional study evaluates an innovative digital questionnaire and computer programme to combine person-reported data with medical data, and auto-calculate fracture and falls risks without the need for clinician time

Introduction: Atrial Fibrillation (AF) causes 15% of ischaemic strokes. The National Clinical Guideline for Stroke recommends at least 24 hours of cardiac monitoring and a longer duration if cardio-embolic stroke is suspected. The British Heart Rhythm Society suggests up to 72 hours of cardiac monitoring. Currently, there is little data on the use of telemetry in detecting AF in acute strokes. Aims: Our study aims to evaluate the detection rate of new onset AF in acute stroke with telemetry and to determine if there was any correlation between the duration of telemetry and the detection rate

Inpatient falls remain a huge problem in hospital, causing significant injuries to patients and are an avoidable cost to the NHS. Therefore, the National Audit of Inpatient Falls (2015-2017) set out key recommendations for management of falls, including the measurement of LSBP within 3 days of hospital admission. Our project was conducted in a major acute teaching hospital in North West London across three geriatric wards. Our aim was to improve the measurement of LSBP and correct documentation across the wards in line with the NAIF guidelines. We excluded patients unable to mobilise to